What Do We Do About Doctors? Countervailing Power (In)Action

There are two aspects to the economics of the medical profession. The first is that of how we should pay them and, of course, how much. From research, there are tried and tested lessons that essentially lead us to a system of remuneration, especially for doctors as the main controllers of resource use in the system, that is based on ‘horses for courses’; a mixed system of remuneration across salaries, fees-per-item-of-service, capitation and others. Despite what some, including health economists, might say, no one of these forms of remuneration is completely wrong or completely right. The particular mix in any given context should be based on what funders (usually governments) are trying to achieve. Secondly, we need to decide on how many of each category of staff we need. Previous ways of planning have obviously not worked, but we keep returning to the same well, reinforcing vested interests, and arriving at periodic staffing crises of which the current one is one of the worst and seemingly (but only seemingly) intractable. There are straightforward ways of doing this better that have only rarely been implemented. These better account for potential to measure real needs and thus match the numbers and types of professionals required to address them. This includes accounting for the potential to substitute advanced nurse practitioners and allied health professionals in roles traditionally seen as the preserve of the medical profession.